Get Id Hw 1040 2014-2025

The ID HW 1040 is an optional referral form for newborn Medicaid coverage in the state of Idaho. This guide will provide you with clear, step-by-step instructions to assist you in filling out the form online, ensuring you provide all necessary information accurately.

Follow the steps to complete the ID HW 1040 online.

1. Click the ‘Get Form’ button to access the ID HW 1040 and open it in your preferred editing tool.
2. Begin by filling out Part 1, designated for the Medicaid provider. Enter your provider name, address, and identifying information of the mother, including their first name, last name, middle initial, address, social security number, and, if known, their Medicaid identification number.
3. Continue by providing the infant's name, date of birth, and sex of the baby. Indicate whether an application has been completed for a Social Security number for the child.
4. Next, fill in the father's details, including their first name, last name, middle initial, address, social security number, date of birth, and phone number.
5. Finally, ensure to place the signature of the provider or provider representative completing Part 1.
6. After completing Part 1, save your changes to the form. You may then download a copy, print it for physical submission, or share it via email as necessary.

Complete your form online today and ensure timely processing of newborn Medicaid coverage.